Types of Stroke

Imagine a normal start to your day, when suddenly your vision blurs, you become very confused, and you can’t seem to keep your balance. You might be having a brain attack. Each year more than 500,000 Americans have brain attacks or strokes, with about 145,000 dying as a result, making stroke the third leading cause of U.S. death’s and the number one cause of serious adult disability.

A brain attack is a sudden interruption of the blood supply to the brain. If the blood flow is not reinstated quickly, brain tissues are deprived of oxygen and can be irreversibly damaged, resulting in a wide range of physical and mental disabilities. There are basically two kinds of strokes:

• Ischemic stroke is the most frequent form of stroke and is usually caused by a clot that blocks a blood vessel in the brain or neck. These clots can originate somewhere else in the body and travel to the brain or they can form in the brain itself. Less frequently, ischemic strokes are caused by plaque buildup leading to severe narrowing of an artery leading to the brain. 
   
• Hemorrhagic stroke is caused by a blood vessel rupturing and bleeding into the brain or the areas surrounding the brain. Sometimes these strokes are caused by aneurysms, which are weak spots in the artery walls. High blood pressure can also cause artery walls to become brittle and crack open. 
    
• Transient ischemic attacks (TIAs): These small strokes may have some of the same symptoms as acute strokes, but the symptoms are temporary. However, TIAs are warnings that a person is at risk for a more disabling stroke. Of the 50,000 Americans who have a TIA each year, about one-third will eventually have a major stroke. If you have a TIA, you should talk to your doctor about treatment to prevent a more serious stroke.

Symptoms
Anyone experiencing the following stroke symptoms should call 911 to get to the Emergency Department immediately:

• Change in vision in one or both eyes
• Weakness or numbness of the face, arm or leg
• Sudden confusion, trouble talking, or understanding speech
• Sudden trouble walking, dizziness or loss of balance
• Severe head pain

There are now some very effective treatments for both kinds of brain attacks that didn’t exist ten years ago. For instance, there are blood clot dissolving medications, such as a drug called t-PA, which can effectively treat many ischemic strokes by breaking up blood clots.

There is also an aggressive treatments, such as the threading of catheters or coils to the blood clot sites. (See Dr. Shanno’s links.) In addition, major hospitals, including Southwest, have organized stroke teams to efficiently respond to brain attacks and provide treatment as quickly as possible.

Quick response
The most important thing to know about a brain attack is to get to the hospital right away. If a person is treated within three hours of a stroke, the possibility of a total recovery increases dramatically.

For treatments to be most effective, they need to be administered quickly before tissue damage has occurred. Clot dissolving medications should be administered within three hours or ideally even less time from the onset of symptoms. Evaluation time also needs to be considered when calculating the time from the onset of symptoms to the delivery of treatment. Once a patient with stroke symptoms arrives at the hospital, an evaluation needs to take place to determine the correct treatment. This usually includes blood tests and a CT-scan, which may take 30 to 45 minutes. Consequently, every minute counts after symptoms begin. The sooner the patient arrives at the hospital the better.

Understanding risks
Controlling the following risk factors for stroke can help prevent strokes in the first place:

• High blood pressure. You can control your blood pressure by maintaining a healthy weight, exercising, and, in some instances, taking medications to reduce blood pressure. 
   
• Cigarette smoking. The only solution to this risk factor is to quit smoking. If you’re having trouble doing this, medications are available. Talk to your doctor. 
   
• Heart disease. Maintain a healthy lifestyle to avoid heart disease, including weight control, a proper diet and regular physical activity. But if you have been diagnosed with heart disease, talk to your doctor about what you can do to reduce your risk of stroke. 
   
• Diabetes. Many of the same factors that comprise diabetes are also risk factors for stroke, including obesity, high cholesterol and high blood pressure. If you have diabetes, talk to your doctor about what you can do to avoid the complications that may lead to increased risk of stroke.

Published Summer 2008.

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